The effectiveness of a preoperative psychotherapeutic intervention with breast cancer patients was assessed in a randomized controlled trial: (1) preoperative interview plus a 30‐minute preoperative psychotherapeutic intervention; (2) preoperative interview plus a 30‐minute chat to control for the effects of attention; (3) preoperative interview only; and (4) routine hospital care control. A clinical psychologist interviewed the patient in hospital the afternoon before surgery. A consultant surgeon trained in listening and counselling skills conducted a 30‐minute psychotherapeutic intervention or chat. Psychological measures included anxiety and depression, body image distress, stressful life events, social support, and coping. Patients receiving a preoperative interview had lower body image distress at 3 months and 1 year than controls. Controls also showed significantly less Fighting Spirit in 1‐year interviews, and more control patients were cases for both anxiety and depression on Present State Examination criteria at 1 year than patients in the experimental groups. The psychotherapeutic intervention was superior to the chat among patients with severe stressful life events. Patients in the chat condition used their 30 minutes with the surgeon to explore symbolically themes of loss and restitution. In a multivariate model for predicting psychological outcome at 3 months and 1 year, experimental group remained a significant predictor when surgical procedure and age were included in the regression equation. Patients undergoing sector mastectomy had lower body image distress scores than mastectomy patients both at 3 months and 1 year. Psychological morbidity in the sample was high preoperatively (59%) and at 1 year (39%), but detection of morbidity by health professionals was poor. Predictors of caseness at follow‐up included caseness preoperatively, severe stressful life events, age, marital status, and social support. Implications of the findings for the care of cancer patients in hospital are discussed.
This study describes a survey of 496 NHS clinical psychologists (65% return rate obtained) looking at professional activities, job‐related stress, views on personal therapy, and details of personal therapy experiences. Forty‐one per cent reported having had experience of personal therapy, a figure lower than in any of the published American samples. Seventy‐eight per cent said they were moderately or very stressed by the job. Those with experience of personal therapy had higher scores on the GHQ‐28 and higher self‐reported scores for stress of the job and stress of doing psychotherapy. More psychologists with a psychodynamic orientation had experience of personal therapy than would have been expected by chance. Psychodynamic therapists chose psychodynamic or psychoanalytic therapists, but cognitive‐behavioural therapists chose therapists of orientations other than their own. Reasons for undertaking and ending therapy, the rated outcome of therapy, and means of finding a therapist are reported. Outcome of therapy was generally positive, with 17% of the sample reporting unsatisfactory results. The results are discussed in the light of published studies and in the context of work‐related stress among clinical psychologists.
The number of elderly people is increasing, and the authors aimed to identify variables associated with older adults' ability to cope with their retirement years. In this study, 133 community-dwelling men and women (M age = 72 years, SD age = 7.6 years) completed a battery of self-report measures. A path analysis showed that internal locus of control (LOC) and good self-rated health were direct predictors of the criterion variable of life coping. However, whereas health remained a stand alone variable, faith in nature and humanity (positive correlation) and the use of coping religion (negative correlation) predicted LOC. Thus, LOC may play a mediatory role between the latter 2 variables and life coping. In turn, spirituality was a predictor of both the faith in nature and humanity variable and the coping religion variable. Additional findings include a positive correlation between self-rated health and seniority of preretirement occupation, a higher health rating for house dwellers compared with bungalow dwellers, and a negative correlation between age and self-rated health. The authors offer some explanations for the outcomes and suggest that the findings will be valuable to those who are responsible for the social welfare of retired people.
Fifty‐one surgical consultants, registrars and senior registrars in NHS hospitals in the West Midlands (UK) were interviewed about psychological aspects of cancer surgery: information given to patients, the bad news interview, psychological risk factors in surgery, psychiatric morbidity, difficult patients, and care of the dying. Information that tended to be provided infrequently included the cause of the disease, the effects of surgery on sexual functioning, and psychological side‐effects of the surgery. Surgeons most often answered incompletely patients' questions about prognosis, effects of surgery on sexual functioning, the presence of malignancy, and probable length of life. Concerning the disclosure of malignancy, 37% said they always tell the patient; 8% tell virtually all patients; 49% tell the patient depending on the patient's and relatives' wishes; and 6% tell the relatives and possibly the patient. A common strategy among 49% is to use the word ‘growth’ and wait for the patient to ask further. Few surgeons took even the briefest psychiatric history, and only the most severe post‐operative psychological complications were referred to psychiatrists. The most difficult patients for surgeons to manage were emotionally labile, angry, demanding, controlling, refusing treatment, or predicting failure. The surgeons in this sample clearly struggled with their role as giver of bad news and with the consequent emotional reactions of the patient. © 1997 John Wiley & Sons, Ltd.
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